Click to download our PDF: why today's bigger, stronger players are increasingly at risk

England play Argentina at Twickenham on Saturday with a starting XV that could, with total justification, have been different in every position. The reason? Players in the alternative XV are injured or recovering form after injury.

A conference starting today at Lensbury, in Teddington, southwest London, will begin the process of discovering whether the game has become too dangerous for its own good.

Medical experts from every one of rugby’s leading countries are involved in the two-day session towards the end of a year that has brought accusations that players have become too big, that referees are ignoring significant aspects of play that lead to injuries and that the demands made on leading players have become far too great.

“We are reaching a level where the players have got too big for their skill levels,” James Robson said at the end of the Lions tour to South Africa in July during which eight players were forced out of the squad by injury. Four more have played little or no rugby this season as a result of injuries suffered in the final match of the tour.

“Players have become a little too muscle-bound and bulky,” said Robson, Scotland’s head of medical services and national team doctor, who was making his fifth Lions tour as team doctor. “You may see changes in the physical nature of the players which brings them back a little — I hope so — in order to speed up the game and introduce a higher level of skills.”

Robson will be among the keynote speakers at Lensbury two days after Judge Jeff Blackett, the RFU disciplinary officer, said that referees and citing officers were at fault for not applying the laws strictly enough and allowing players to enter rucks illegally. “Much has been written about bulky players, big hits, violence in the game and too many matches,” Blackett, giving the annual Obolensky lecture for The Sunday Times, said.

“We are not applying the laws of the game or we are interpreting them too freely. If referees and citing officers applied the rules more rigidly, we may see a reduction of injuries at the breakdown. There is a balance between dynamism and safety, and I think it has gone too far in the wrong direction. In an effort to increase the attractiveness of the competition, we are in danger of damaging the game.”

The Lensbury conference is organised by the IRB as the starting point for a sea change in its medical strategy. The planning began last year and the speakers include Robson and Colin Fuller, from the University of Nottingham. They will discuss the physicality of the game, with the aim of identifying the medical and player-welfare issues involved and making appropriate recommendations. They will be joined by Simon Kemp, the RFU’s head of medicine, whose brief includes spinal-cord injuries.

Robson and Mick Molloy, the IRB medical officer, will also lead a debate on concussion. The medical representatives from the other home unions, the Sanzar unions, France, Argentina, Italy, Japan, Canada, Hong Kong and Singapore will be present. “It’s good to have this with people who might exert some influence,” Robson said. “We don’t talk to each other often enough.”

The previous occasion on which the medical representatives met was the 2007 World Cup, since when the IRB has disbanded its medical advisory committee before building a more powerful body. During that tournament, the board signed a memorandum of agreement with the International Rugby Players’ Association (IRPA), which will be represented at Lensbury by Damian Hopley, from England, and Rob Nichol, the IRPA chief executive.

It is crucial that the players’ voice is heard on such an occasion and, to its credit, the IRB has worked closely with the players’ professional body over the past two years, notably in projecting sevens into the Olympic programme. “I’m really heartened at what is being done,” Robson said. “I’ve spoken about my views and the way the game is going and it seems others have been prompted to offer the same opinions.

“It has been suggested by current players that too much time is being spent in the gym and not enough on the playing field. What I have said relies on anecdotal evidence but it’s important now to look at whatever statistical evidence is available. It feels as though, over the past 12 months, attrition rates have become too high. I don’t have the answer but we need to establish what should be done about it.”

The best injury audits are those kept by England, South Africa and New Zealand. Their statistical analyses include figures for which parts of the body suffer most and which phase of play brings the most injuries. It will be the IRB’s role to encourage all the leading unions to augment their data, based on the criteria in use in the three main countries for injury identification.

Recommendations from the conference will go before the IRB’s executive committee, though if urgent action is required, it can be recommended to the IRB council on December 1 in Dublin.

It is no coincidence that, when the leading referees concluded their annual meeting yesterday, they had also considered illegal clear-outs at the breakdown where injuries such as the dislocated shoulder suffered by Adam Jones, the Lions prop, occurred during the second international of the series. Jones was hit by Bakkies Botha, the Springbok lock, who was subsequently given only a two-week suspension while Jones has yet to return to the game. Referees have to decide whether players are legitimately joining rucks and mauls or illegally inflicting damage on opponents.

“Is this a statistical blip and will we see fewer injuries in another season?” Robson said. “My anxiety is that it should not be a trend and, if it is, it needs someone to spot it. But it’s getting to a point that, every time you go on a website or open a paper, another leading player has been injured.”